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37.86.2225    EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES (EPSDT) , CSCT PROGRAM BILLING

(1) Comprehensive school and community treatment (CSCT) services must be provided as set forth in ARM 37.106.1955, 37.106.1956, 37.106.1960, 37.106.1961 and 37.106.1965 in order to receive payment under this program.

(2) One full-time equivalent team may bill no more than 720 billing units per team per month. If a child or adolescent receives CSCT services during time periods when school is not regularly in session, then part-time staff may be used but the billing units must be reduced proportionately.

(a) A billing unit is 15 minutes.

(3) CSCT services provided by a licensed mental health center with an endorsement under ARM 37.106.1955 must be billed under the school district's provider number. Mental health services that are provided outside, or concurrently, with the CSCT program are billed under the mental health center's provider number with the appropriate CPT-4 procedure codes describing the services provided.

(4) As a Medicaid provider of CSCT services, the school district is subject to all Medicaid state and federal billing rules and regulations. A school district must:

(a) use a sliding fee schedule for children or adolescents not eligible for Medicaid;

(b) bill all available financial resources for support of services including third party insurance and parent payments if applicable; and

(c) adequately document services to support the Medicaid reimbursement received.

(5) There must be an appropriate level of direct contributions by the school district. Appropriate level means no less than is necessary to meet the nonfederal match requirements.

History: 53-2-201, 53-6-113, MCA; IMP, 50-5-103, 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA; NEW, 2005 MAR p. 1786, Eff. 9/23/05.

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